Event Feedback Form

1

Your Name* This field is required.

First Name

Last Name

2

What is the name of your school or organization?* This field is required.

3

E-mail* This field is required.

4

Phone Number* This field is required.

Area Code

Phone Number

5

LinkedIn Profile

6

Was Dr. Alex's talk valuable to you today?* This field is required.

YESNO

7

Was Dr. Alex's session actionable?* This field is required.

Boring

Fantastic

12

Do you book paid speakers for events?

Yes!

No

No, but I know someone who does!

13

How likely are you to attend future talks by Dr. Alex on other topics?* This field is required.

Definitely Yes 😁

Probably Yes 🙂

Probably Not 😐

Definitely Not 😬

14

How can Dr. Alex contact you about this opportunity?* This field is required.

Email

Phone

15

Would you like to book Dr. Alex for a future paid speaking engagement?* This field is required.

Yes, within the next 6 months

Yes, but not sure when

Not at this time

16

Could you provide more details about the opportunity you're interested in booking Dr. Alex for?* This field is required.

17

If you had to describe this session to a friend or colleague, what would you say?* This field is required.Your detailed insight is invaluable!

18

What else should Dr. Alex or the event organizer know?* This field is required.Everything you share helps us better.